Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Intro to D&D Midterm > Saad - Osteoarthritis part 2 > Flashcards

Saad - Osteoarthritis part 2 Flashcards

1
Q

aside from GI , name 2 other potential NSAID toxicities

A

Cardiovascular
renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how do NSAIDS have CV toxicity concern

A

they can increase blood pressure and exacerbate congestive heart failure

seen with all NSAIDS used chronically (naproxen may be least harmful)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

chronic use of NSAIDS have increased risk of CV events

which NSAID may be the least harmful in this regard?

A

naproxen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Explain the risk/benefit of NSAIDS and CV toxicity

A

the overall risk is small – however if it does happen could be life threatening
benefit is relief of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

NSAIDS are contraindicated before and after _____ surgery

A

CABG

coronary artery bypass graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

NSAIDS being used with what 2 classes of drugs has renal toxicity concern? explain

A

NSAIDS + ACE inhibitors or diuretics

can reduce blood flow to kidneys and cause toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

name a sulfonamide NSAID that must be avoided in patients allergic to sulfa

A

celecoxib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

true or false

NSAIDS should be avoided in the renally impaired

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

name 2 hypersensitivity reactions of NSAIDS

A

rash, bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

*** what is the NSAID only approved for SHORT TERM USE?
WHY?
how long?

A

ketorolac

less than or equal to 5 days

it is extremely potent – thus has the most GI, renal, CV side effects

give to patients requiring opioid-like pain relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

NSAIDS with _____ and ________ cause more GI side effects

A

a long half life
extended release dosage form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

name the 3 systems that are a concern for toxicity when taking NSAIDS

A

GI
CV
kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

explain the NSAID + ASA (aspirin) interaction

A

NSAIDS block COX1 – aspirin cant access

ONLY if NSAID is taken before aspirin

NSAIDS block the antiplatelet effects of aspirin (if taken before) – have reversible and variable antiplatelet effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

**important:

when should ibuprofen and aspirin be taken to avoid interaction

A

take aspirin 30 mins BEFORE ibuprofen

if pt already took ibuprofen, have to wait at least 8 hours to take the aspirin – so that COX1 isnt blocked by it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

true or false

opioids are 1st line and used for initial management of OA pain

A

false

risk of abuse – OA is chronic
not used for initial management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when may opioids be useful in OA patients?

A

those who dont get much relief from NSAIDS, aspirin, intra articular injections or topical therapy

(or they cant tolerate side effects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

true or false

data on opioids fails to demonstrate a clear benefit for chronic pain

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

do opioids and tramadol have the same side effects?

A

yes - but lower abuse potential and tramadol less potent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

tramadol is contraindicated during or within 14 days following _________ therapy or other medication with __________ activity.
why?

A

MAO inhibitor
or other med with serotonin activity

risk of serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

true or false

tramadol is available as a stand alone and with acetaminophen

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

true or false

tramadol requires dose adjustment in renal failure

A

true (max 200mg a day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

max daily dose tramadol with normal renal function

A

400mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what DEA class is tramadol

A

schedule 4 control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

name some tramadol adverse effects

A

CNS depression
drowsiness, dizziness
constipation
resp depression
tolerance
addiction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

tramadol should be given with caution if the patient is taking….

A

meds that lower the seizure threshold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

true or false

duloxetine and tramadol should be given with caution

A

true

serotonin syndrome risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

name 2 topical OA therapies

A

capsaicin
diclofenac (voltaren)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

TRUE OR FALSE

topical OA therapies cannot be used in combination with other pharmacologic therapies for OA

A

FALSE - they can

29
Q

name an advantage that topical therapies have over oral for OA

A

ppl unable to tolerate oral NSAIDS bc GI/renal/cardiac side effects can take

30
Q

How does capsaicin work to reduce pain

A

depeletes substance P - neurotransmitter

31
Q

in which OA areas are capsaicin most effective?
in which joint is it least effective?

A

most effective in hands and knees

not very for hip

32
Q

in which area should capsaicin definitely not be applied

A

any mucous membranes - severe burning

33
Q

is capsaicin recommended for initial management of OA pain?

A

no - but can be used if other treatments fail

34
Q

what is an advantage of capsaicin over other pain relief OA therapies

A

no systemic adverse effects

35
Q

how long does capsaicin take to give analgesic effect after applied?

A

3-5 days
*will burn initially

may take several weeks for MAXIMAL effect

36
Q

how many times a day is capsaicin applied

A

3-4 times

37
Q

explain how you would counsel a patient on how to use capsacin

A

wear gloves and avoid cutaneouos/mucus membranes
may take 3-5 days to work, will burn at first, up to several weeks to see max effect

38
Q

are topical NSAIDS systemically absorbed?

A

minimal-none

39
Q

the ACR strongly recommends topical rather than oral NSAIDS for which age range?

A

greater than or equal to 75 years

40
Q

the efficacy of topical NSAIDS has been observed in which 2 kinds of OA?

A

knee and hand

41
Q

diclofenac gel/solution/patches typically requires ____ times daily dosing

A

4

42
Q

name an NSAID that can be compounded to be topically applied

A

ketoprofen

43
Q

what was the theory of using hyaluronic acid in OA patients

A

thought was that they would act as a shock absorber in synovial fluid and provide elasticity

-efficacy is questionable and response is very variable

44
Q

ACR conditionally recommends against the use of intrarticular hylauronic acid in ______ OA and STRONGLY recommended against it in ____ OA

A

knee
hip

45
Q

what is an advantage of IA hyaluronic acid over other agents

A

avoiding systemic side effects

46
Q

many hyaluronic acid injections are contraindicated in patients with what allergy?

A

avian (bird)

47
Q

besides patients with avian allergies, where else is IA hyaluronic acid contraindicated

A

in an infected joint space

48
Q

explain the clinical evidence of hylauronic acid in OA patients

A

cannot be confirmed

response seems to be variable, efficacy is questionable. may just be placebo effect

question of whether the mass influences efficacy

49
Q

what are some adverse effects of intra articular hyaluronic acid injections

A

local pain, itching, joint swelling, ecchymosis (bruise)

50
Q

are intra-articular STEROIDS beneficial in OA patients?

A

yes - for acute flares, effusion, and severe OA

51
Q

TRUE OR FALSE

oral and intra-articular steroids have use in OA patients

A

FALSE - only intra-articular

52
Q

as mentioned, intra-articular steroid injections can be used in OA patients in cases of localized effusions

what is a consideration with this?

A

the fluid must be aspirated before injecting if there is an effusion

53
Q

repeated intra-articular steroid injections may cause…..

A

bone loss and/or tendon rupture

54
Q

the dose of intra-articular steroid injections depends on what

A

the size of the joint

55
Q

localized side effects of intra-articular steroid injection

A

localized inflammatory reaction

56
Q

what would you tell a pt getting intra articular steroid
include how long it may take to work and what to avoid

A

should begin in 2-3 days and last 4-8 weeks

avoid straining the joint a few weeks after injection

57
Q

name some SYSTEMIC side effects of intra articular steroids

A

edema, inc BP, hyperglycemia, dyspepsia, hypercorticolism

58
Q

does the ACR recommend glucosamine/chondroitin for OA?

A

ACR really only mentions chondroitin as conditionally rec for hand OA but strongly rec AGAINST in knee/hip.
but it’s mainly sold as a combination product with glucosamine

59
Q

how is glucosamine/chrondroitin thought to work in OA patients

A

it stimulates proteoglycan synthesis from articular cartilage – help maintain hydrostatic pressure depsite the compressiong pressure

glucosamine - “building block” for cartialge

chondroitin sulfate “water magnet” in cartilage

60
Q

what is an advantage of glucosamine/chondroitin over oral NSAIDS

A

can avoid the GI/CV systemic side effects in pts predisposed to these – safer

61
Q

explain the effectiveness of glucosamine/chondroitin over an NSAID like celecoxib

A

in a study, combo was not better than celecoxib at relieving pain

62
Q

name some AE of glucosamine/chondroitin

A

mild GI discomfort like gas and bloating

63
Q

________________ should be avoided in SHELLFISH ALLERGY

A

glucosamine

64
Q

__________ should be avoided in cattle, shark, pink allergy

A

chondroitin

65
Q

if glucosamine/chondroitin will show effect, how long will it take

A

4-8 weeks

66
Q

why are glucosamine/chondroitin studies not reliable (aside from placebo effect)

A

they only measure patient symptoms and no changes in morphology

67
Q

what are DMOADS

A

disease modifying OA drugs

68
Q

name a supplement that may be just as effective as oral NSAIDS in OA patients

A

turmeric

69
Q
A

Intro to D&D Midterm (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions